On-line Training Access

LSU Exposure Control Plan

Introduction

Louisiana State University (LSU) follows federal regulations and guidelines in the
conduct of research and other activities which might place personnel in direct contact
with blood that could potentially contain infectious agents, known as bloodborne pathogens
(see PS-65).The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard
(BBP, 29 CFR 1910.1030) builds on the implementation of the universal precautions,
specifying the need for control methods, training, compliance and record keeping.
The BBP Standard is a “performance” standard, meaning the employer has a mandate to
develop an exposure control plan to provide a safe work environment but is allowed
some discretion in how this goal is accomplished.

Blood and unfixed tissues of human origin can contain a variety of potential pathogens
that can infect humans. The human immunodeficiency viruses, HIV-1 and HIV-2, are the
most notorious of these agents, but there are many other viruses and bacterial pathogens
that may be present as well. Viruses found in blood include two unrelated hepatitis
viruses, the hepatitis B virus (HBV) and the hepatitis C virus (HCV). In addition,
there are retroviruses other than HIV (HTLV-I, HTLV-II), encephalitis viruses, certain
protozoans, and bacteria such as Treponema pallidum which may be present in human
blood.

Hepatitis B virus (HBV) is a hepadnavirus that infects a large number of people worldwide
and is an important cause of liver disease and hepatocellular carcinoma. It is more
infectious than HIV and often co-infects the same people; both agents may be present
in the same blood sample. A safe and effective vaccine is available and vaccination
(or declination) is required by the OSHA BBP Standard for all persons who are occupationally
exposed to blood or other potentially infectious materials. Hepatitis C virus (HCV),
a flavivirus related to yellow fever virus, infects an estimated 4 million people
in the U.S. alone. New infections are estimated to occur at about 300,000 per year,
and it is the leading cause of liver failure. Unlike HBV, HCV nearly always establishes
a chronic, persistent infection and is often asymptomatic, and no vaccine is currently
available.

Universities are unique because of the diversity of potential occupational exposures
to bloodborne pathogens, including research laboratories where the study of these
agents is conducted. Working with the human immunodeficiency virus (HIV) and other
bloodborne pathogens requires special precautions to protect researchers from infection.
While the bloodborne pathogen regulations apply only to human blood, all blood should
be handled as if it contains pathogens. There are many potential zoonotic pathogens
which may be present in the blood of a variety of animal species that can infect humans.
Prudent safety practices, such as adherence to the universal precautions will protect
researchers and others.

Universal Precautions

The universal precautions are a set of guidelines developed in the 1980’s to minimize
the risk of health care workers to HIV infection. The universal precautions are developed
around the idea that all blood and certain body fluids should always be treated as
though infected with HIV and other bloodborne pathogens. All health care workers should
routinely use appropriate barrier precautions to prevent skin and mucous membrane
exposure during contact with any patient’s blood or body fluids. The universal precautions
apply to blood, other body fluids containing visible blood, semen and vaginal secretions.
The universal precautions also apply to tissues and to the following fluids: cerebrospinal,
synovial, pleural, peritoneal, pericardial, and amniotic fluids. They do not apply
to feces, nasal secretions, sputum, sweat, tears, urine and vomitus unless these substances
contain visible blood. Universal precautions do not apply to saliva except when visibly
contaminated with blood or in the dental setting where blood contaminated saliva is
predictable.

The Centers for Disease Control and Prevention in 1989 issued guidelines for the application
of the universal precautions, primarily aimed at health care facilities, but applicable
to a variety of work settings including laboratories. These guidelines recommend following
the steps outlined below:

All work activities should be classified according to the potential for exposure.
Tasks with a greater potential for exposure have a greater need for appropriate protective
equipment. As a minimum, gloves, protective clothing and eye protection should be
worn at all times when there is a reasonable potential for exposure

A detailed work practice program should be developed that includes standard operating
procedures (SOPs) for all activities having the potential for exposure. Once these
SOPs are developed, a worker education program is implemented to assure familiarity
with work practices for potentially exposed workers. No worker should engage in tasks
or activities that potentially put them at risk of exposure before receiving training
pertaining to the SOPs, work practices and protective equipment required for that
task.

The employer should monitor workers to insure that the required work practices are
observed and that protective clothing and equipment are provided and properly used.
Records documenting the procedures and criteria used to assess the risk of job activities
should be maintained. Copies of all standard operating procedures (SOPs) for tasks
or activities involving predictable or unpredictable exposure to blood or other body
fluids should also be kept on file, and made accessible to employees. In addition,
training records including the dates of training sessions, the content of the sessions
and the name and qualifications of the individuals providing the training should also
be kept.

Requirements of the OSHA Bloodborne Pathogen Standard

The OSHA BBP standard builds on and extends the universal precautions and adds additional
requirements for records, health monitoring and training. Institutions are required
to prepare an exposure control plan. Click this link to access the LSU Exposure Control Plan. The following is a brief explanation of the components of the exposure control plan:

Engineering Controls

Louisiana State University biological safety office requires the use of available
technology to minimize, isolate or otherwise neutralize the risk of hazards to laboratory
workers. Since parenteral exposure due to percutaneous injuries is the main risk posed
by bloodborne pathogens, a major emphasis is on the prevention of sharps-related injuries.
About 90% of the documented HIV infections resulting from laboratory exposures are
due to percutaneous injuries; most are from injuries involving hollow-bore needles.
Safety devices such as retracting needles and needle-less injection systems are required
to be substituted wherever possible.

Work Practices

The way tasks are carried out can minimize the potential for exposure to infectious
pathogens. In the conduct of any activity that places the worker at risk of exposure,
methods that reduce the likelihood of contact with potentially infectious materials
should be used. Splashes and the generation of aerosols must be avoided.For research or teaching related activities, standard microbiological practices have
been recommended by the CDC and by the NIH for all laboratory containment levels.
These practices have been designed to prevent indirect transmission of infectious
material from environmental surfaces to the hands and from the hands to the mouth
or mucous membranes. Such practices include the prohibition of mouth-pipetting, eating,
drinking, smoking, applying cosmetics or handling contact lenses while in the laboratory.
The practices also are intended to minimize environmental contamination. These recommended
work practices must be strictly adhered to in the conduct of all research or teaching
activities.

Personal Protective Equipment (PPE)

Exposure to laboratory workers can be minimized by the appropriate and effective use
of personal protective equipment (PPE). What constitutes appropriate PPE is determined
by the procedure being conducted and the type, duration and extent of exposure.

Training

An important component to exposure control is training. On-the-job training is not
an acceptable alternative to formal safety training. Interactive training sessions
must be conducted upon initial hiring and annually thereafter. Training must be conducted
by an individual who is knowledgeable about the OSHA standard, safety and the pathogens
potentially present.Employees must be educated about their risk and the institution’s plan to control
these risks. There must be no charge for training to the employee, be available during
working hours and be understood by the employee. The topics required to be covered
by training include:

Accessibility of the OSHA Bloodborne pathogen standard and Institutional exposure
control plan.

Epidemiology, transmission and symptoms of common bloodborne pathogens.

For more information or to arrange for bloodborne pathogen training, contact the LSU
Environmental Health and Safety (EHS) office at 578-5640.

Medical Care and Monitoring

The exposure control plan is primarily intended to prevent accidental infections,
but it also contains specific requirements for hepatitis B vaccination and post-exposure
medical care. The hepatitis B vaccine is a safe and effective way to prevent infection
with this virus. It consists of a series of three injections of the HbSAg, a major
viral surface protein which has been correlated with immunity. Employees must either
be vaccinated at the employers expense or sign a waiver indicating they understand
the risks of exposure and decline to be vaccinated.The use of preventive strategies will not completely eliminate the possibility of
exposure to infectious materials. Because of this fact, the plan includes a post-exposure
evaluation program. For laboratory workers who handle blood, concentrated HIV or other
infectious materials, the plan requires a confidential medical evaluation, follow-up
and documentation of an exposure incident. An exposure incident is defined as “specific
eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood
or other potentially infectious materials that results from the performance of an
employee’s duties.” LSU follows the CDC guidelines for post-exposure measures for
exposures to HIV, hepatitis B virus and hepatitis C virus, which is available on line
from the CDC athttp://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf.Post-exposure management may include HBV vaccine booster, anti-retroviral chemotherapy
and/or immune gamma globulin injections. The LSU Student Health Center works with
EHS to manage vaccinations and post-exposure control.